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H P Meier-Baumgartner

Publications and source records attributed to H P Meier-Baumgartner.

At least 19 recordsLinked to original sources
PubMed2003

[Preventative home visits by a specially trained nurse for 60-year olds and elderly in Hamburg].

There is increasing interest in home visits by phycisians, nurses or occupational therapists which offer health promotion or preventive care to older people. However, the practical performance of home visits, the targeting, and the effectiveness are ambigious. The collaboration in the EU-study 'disability prevention' gave the opportunity to recruit non-selected people 60 years and older from 14 general practitioners' patient lists in Hamburg. The study participants were offered different programs of health promotion, i. e., group sessions at the geriatric center and preventive home visits. The home visits were made by a nurse who received special training, and a curriculum was established. Seventy-seven elderly persons were visited because they were not able to attend the group sessions at the geriatric center due to self-reported problems in mobility. The investigations revealed combined risks for development of functional decline and dependency in the majority of these community dwelling elderly persons. These findings were unknown to the general practitioners. For example, the risk of falling as recorded by assessment was elevated in more than half of the persons visited. Screening and assessment are useful for planing measures of health promotion and prevention. There are still questions open to discussion. The targeting, practicability, and prerequisites in structure of service provision are considered with regard to the present study's results and an upto date literature review.

Activities of Daily Living↗
PubMed2002

[Knowledge concerning illness, expectations and perceptions of treatment of elderly stroke patients and family caregivers--a prospective study during inpatient treatment].

Forty-five stroke patients and their 45 proxies were interviewed after the patients' hospital admission and before discharge. The topics of the interviews were disease knowledge, expectations in and judgement about therapy, estimation of functional health status (CCOP/WONCA Charts), and prognosis. The patients and proxies were also asked to name the patient's actual three most important health problems. The depressive symptomatology in the patients (geriatric depression scale) and their ADL status (Barthel Index) were evaluated on admission and before hospital discharge. The proxies' general knowledge of disease was superior compared to that of the patients. There were knowledge deficits regarding individual risk factors and secondary prevention, in particular. Information was predominantly obtained from physicians. However, an additional need for information on prognosis and prevention, in particular, was expressed by patients and proxies before hospital discharge. There was a high agreement between the patients and their proxies in mentioning the patients' actual three most important health problems, apart from psychological problems. These were mentioned only by the proxies but not by the patients themselves. Depressive symptomatology in the patients increased significantly. There were associations of depression with the level of the Barthel Index score and the patients' self-estimation of functional health status before and after the stroke. Full recovery was expected by one half of the patients, on admission. The patients' primary therapeutic goal was the ability to walk again. Their ADL status improved significantly, as measured by a mean increase in the Barthel Index score by 22 points. The patients and their proxies, as well, judged the result of treatment equally high. The proxies' total satisfaction with patient care was significantly related to their ratings of separate parts of patient care regarding nurses, therapists, and physicians, to their expectations in therapy, and the satisfaction of their own personal needs. The results of the study revealed a particular need for information on prognosis and secondary prevention of stroke. Furthermore, depression and coping with consequences of the disease should be important issues in counselling of stroke patients and their proxies. The results regarding patient and proxy satisfaction with care were of importance for internal discussion in the clinic.

Activities of Daily Living↗
PubMed2002

[Editorial].

Explore the source record for details and available documents.

Editorial↗
PubMed2001

[Geriatrics--imbedding into the health care scheme of Germany].

In this paper, we first give an overview of the origins of geriatrics. We then give a description of the development of modern geriatrics in the United States and Great Britain, based on the work of Nascher and Warren. Finally, we give an account of the development of geriatrics in Germany. Clinical geriatrics, which first developed 20-30 years ago, has shown a high rate of growth in the last few years. However, recently there has been a slowing down in this rate of growth--if not a complete halt or, indeed, a counter-movement. The reasons for this somewhat negative development in the past five years are comprehensively discussed. In the last part of the paper, improvements which could be made in geriatrics are described, thus possibly achieving a uniform and self-assured provision of geriatric care in the future, in relation to four priority areas, with regard to outpatient and inpatient care. The first priority area is the care of geriatric patients at home and in nursing homes. To this end, geriatrics in priority areas will be promoted. The second priority is the development of geriatrics in hospitals (acute geriatrics departments and departments with rehabilitation as their focuses of activity). A third priority is geriatric rehabilitation clinics. Finally, we need a few geriatric centers in Germany (centers of excellence), geriatric departments with professorial positions and university clinics with geriatric departments in which geriatrics is taught and from which the impulse for research will be given.

Aged↗
PubMed2001

[Severe decubitus ulcer: risk factors and nursing requirements in the terminal life phase].

UNLABELLED: We present an analysis of the risk factors, the origin and the nursing and medical practice of 140 deaths with high-grade pressure sores which had been detected by post-mortem examination before cremation. METHODS: All available nursing and medical records from nursing homes and hospitals were screened; in addition, relatives and head nurses were interviewed. The data sources were screened for individual risk factors, information about pressure sore prevention and treatment activities by nursing staff and general practitioners. Moreover, the utilization of pressure relieving devices for patients before and after development of the final decubitus was analyzed. RESULTS: More than 50% of the pressure ulcers had been incident in nursing homes. The mean duration of the disease was 307 days (median duration 123 days); the maximum duration ranged up to about 6 years. As far as it could be judged from the nursing records, there was a shortfall of nursing quality in terms of prevention efforts which appeared to be frequently inadequate in relation to the risk profile of the residents. Standardized pressure sore record files were missing in most of the cases. General practitioners were not involved in the treatment in 20% of all cases; some of them prescribed an obsolete wound management. In this study 52% of the patients had been classified into the maximum grade within the three-stage German nursing care insurance scheme. In cases of private care information about utilization of financial support and of professional help should be enforced. DISCUSSION: Being an indicator of nursing quality, shortfalls of prevention measures should be combatted by a broad pattern of quality management strategies which could be adapted from the clinical sector.

Adult↗
PubMed2001

Predictors of favorable outcome in elderly stroke patients two years after discharge from geriatric rehabilitation.

This study was done to determine the independent predictors of long-term survival and long-term functional outcome in geriatric stroke patients with a high level of co-morbidity. We prospectively recruited 302 consecutive patients transferred from local hospitals of acute care to inpatient geriatric rehabilitation with a median of 23 days after stroke. The cohort with a mean age of 75.1 (range 60-90) years was followed up for 2 years after discharge from rehabilitation. The 24 month survival rate was 71.2%. Urinary continence (p = 0.000), younger age (p = 0.000), and absence of coronary artery disease (CAD) (p = 0.039) were predictors of survival. Independence in activities of daily living (Barthel Index (BI) > or = 85) 24 months after discharge was 43.2% and predicted by an admission BI > or = 50 (p = 0.000), urinary continence (p = 0.007), and absence of CAD (p = 0.018). Good functional outcome by the Modified Rankin Scale (MRS < or = 3) 24 months after discharge was 38.4%. It was predicted by absence of CAD (p = 0.001), first-ever stroke (p = 0.014), admission BI > or = 50 (p = 0.024), urinary continence (p = 0.025), mild motor paresis (p = 0.032), and good sitting balance (p = 0.039). Our study of a relatively aged and co-morbid stroke cohort confirmed most of the well-known predictors of outcome. A new result is that CAD also seems to be an important determinant of long-term outcome.

Aged↗
PubMed2001

[Geriatric care in Germany--results of an empirical study].

BACKGROUND: In Germany, the situation of geriatric medicine has improved significantly over the past few years. Until now, though, there was little information available on the structure of the clinical geriatric departments. Since this information is vital to assess whether these departments can provide high-quality services, the German Federal Association of Clinical Geriatric Departments conducted a survey among its members. The goal was to gain deeper insight into the structure of the geriatric acute hospitals and rehabilitation units. METHODS: In 1999, member institutions were mailed a standardized questionnaire and all institutions (100%) returned the questionnaire to the association's central office. To increase data quality, data were screened and reports were generated for each institution. These reports were returned to the institutions which were asked to verify them. RESULTS: This article shows that in 1998 acute geriatric hospitals (n = 89), rehabilitation units (n = 52), acute day clinics (n = 45) and rehabilitation day clinics (n = 26) had--on average--60/60/15.3/14 beds/places and 828.15/677.3/164.2/125.9 patients. Occupancy rates averaged out at 88.7%/84.3%/86.4%/63.7% and daily hospital rates at DM 401.4/322.4/293.8/243.2. Basically, all geriatric institutions included in this survey had a multi-professional geriatric team. Patient-to-staff ratios for psychologists, social workers, ergo-, physio- and speech therapists were better in day clinics than in in-patient clinics and better in rehabilitation units than in acute hospitals. Geriatric institutions mainly focused on the treatment of neurological deficits. Most patients were admitted from other hospitals and discharged to their private residence. CONCLUSIONS: The results of this survey indicate that especially the acute hospitals are often not sufficiently staffed. Moreover, further efforts are necessary to clarify the indications for and modalities of geriatric day clinic treatment and rehabilitation. The data also show that a categorical distinction between geriatric acute hospitals and rehabilitation units is not possible. However, further data collection and more detailed analyses are needed.

Aged↗
PubMed2000

Subnormal serum vitamin B12 and behavioural and psychological symptoms in Alzheimer's disease.

The objective of this study was to examine whether patients with Alzheimer's disease (AD) with subnormal vitamin B12 levels show more frequent behavioural and psychological symptoms of dementia (BPSD) than AD patients with normal vitamin B12 levels. The design was a prospective case-control study. The study took place at a memory-clinic of a department of geriatric medicine in a teaching hospital. There were seventy-three consecutive outpatients with probable AD, including 61 patients with normal and 12 patients with subnormal (<200 pg/ml) vitamin B12. BPSD were measured using the subscales disturbed behaviour and mood of the Nurses' Observation Scale for Geriatric Patients (NOSGER), the Cornell Scale for Depression and the four criteria for personality change in dementia from the International Classification of Diseases (ICD-10). Controlling for dementia duration and degree of severity of the cognitive deficits, there were significant inverse associations between vitamin B12 status and ICD-10 irritability (p=0.045) and NOSGER subscale disturbed behaviour (p=0.015). Low vitamin B12 serum levels are associated with BPSD in AD. Vitamin B12 could play a role in the pathogenesis of behavioural changes in AD.

Aged↗
PubMed1999

[The rehabilitation of older people].

Although age itself is not a disease, older people are more likely to contact diseases. These diseases and the loss of facilities in old age can develop slowly and almost unnoticed or can result from an acute illness. It is always important to intervene in good time as for older people spontaneous healing is often impossible without rehabilitation. This article deals with the development of geriatrics in Germany and introduces the institutions for geriatric rehabilitation. Taking the example of the geriatric department, it will describe in-patient and partial in-patient rehabilitation, the geriatric day clinic with out-patient rehabilitation and the rehabilitation team. The article ends by formulating some demands of governmental health policies and points out that nowadays the success of geriatric work is measurable.

Aged↗
PubMed1999

[Accidental fall-induced, proximal femoral fracture in the elderly--etiology and rehabilitation].

55 patients aged 65 years and older with a fracture of the proximal end of femur caused by a fall who have been admitted to the Medizinisch-Geriatrische Klinik Albertinen-Haus Hamburg for rehabilitation during the period of half a year took part in the study. Aim of the study was to describe the success of treatment as well as to prevent further falls by identifying the reason for their recent fall. Three defined moments are the basis of this analysis: admission and discharge of the Albertinen-Haus and a follow-up research four years later by interviewing their general practitioners. In addition the general physical condition and life surroundings prior to the fall have been evaluated by an anamnestic questionnaire. The average age was 81.1 years. All but three had been living at home prior to the fall and 72% could be discharged to their home after rehabilitation. Five patients died while still at hospital. The reason for falling has been classified into intrinsic and extrinsic factors. Twenty-six patients (47.3%) toppled due to an extrinsic and 20 (36.4%) due to an intrinsic cause. In nine cases (16.4%) no reason could be identified. No correlation between the patient's age and the success of treatment was found. However, the fear to fall again had a significant negative influence on the success of treatment. The inquiry of 45 patients four years later showed that 42.2% were living at home and 31.1% in a nursing home. Within the four years 26.7% died; 93.7% of the surviving patients were able to walk.

Accidental Falls↗
PubMed1999

[Quality assurance in geriatric medicine].

This article describes the peculiarities of geriatric quality assurance from the view of a clinical setting. Description of structural elements of quality are well known. Improvements in process quality of individual patient care have been sustained by controlled studies on comprehensive geriatric assessment. However, implementation of results from comprehensive assessment into external rating systems for hospital accreditation/certification still needs further research. The documentation of product quality depends on the measurement of patients' independency, activities of daily living and subjective well being.

Aged↗